Hypertension - Lecture 1 (General Principles and Management)

Question 1

% of Adults in USA with BP >130/80?

Answer 1

> 45%

24% controlled condition

Question 2

uncontrollable risk factors for HTN?

Answer 2

Race
Family History
Age

Question 3

Controllable risk factors for HTN?

Answer 3

Obesity
Poor diet, high Na intake
Alcohol
Sedentary lifestyle 
Stress
Smoking

Question 4

2014 JNC-8 Guidelines

Answer 4

Pre-HTN = 120 - 139/<80-89
Stage 1 HTN = 140-159/90-99
Stage 2 HTN = >160/100

Question 5

2017 ACC/AHA Guidelines

Answer 5

elevated BP = 120-129/<80
Stage 1 = 130-139/80-89
Stage 2 = 140-149/90-99
Stage 2 = >160/>100

Question 6

When can you recommend lifestyle changes for BP?

Answer 6

all stages

Question 7

Non-pharmacological therapy for BP

Answer 7

DASH diet
lose weight
increase activity, decrease sedentary time
low salt diet
quit smoking
decrease alcohol consumptions

Question 8

Which non-pharmacological therapy has biggest effect on BP?

Answer 8

Dash diet

Question 9

What stage of HTN require pharmacologic therapy?

Answer 9

Stage 1

Question 10

Plan for measuring BP

Answer 10

2 reading in AM before taking med
2 reading in PM before bed

Ideally do for 7 days

Question 11

1st line according to ACC/AHA

Answer 11

thiazide
CCB
ACEi or ARBs

Question 12

Pulse used to evaluate for PVD?

Answer 12

Popliteal pulse
Dorsalis Pedis Pulse
Posterior Tibial Pulse

Question 13

Pulse used to evaluate HR?

Answer 13

Femoral
Brachial
Radial

Question 14

The diaphragm of stethoscope best for hearing…

Answer 14

high pitched sounds like….

Systolic murmurs
Ejection clicks
S1/S2

Question 15

The bell of stethoscope best for hearing….

Answer 15

Low pitched sounds like

Diastolic murmur, S3/S4

Question 16

Where is pulmonary valve located

Answer 16

2nd left intracoastal space

Question 17

Where is aortic valve located

Answer 17

2nd right intracoastal space

Question 18

Where is tricuspid valve located

Answer 18

4th left intracoastal space

Question 19

Where is mitral valve located

Answer 19

5th left intracoastal space

Question 20

Where do you start chest exam?

Answer 20

Aortic - pulmonary - tricuspid - mitral

Question 21

What is the “Lub” sound of the heart?

Answer 21

S1, first sound

Question 22

What is the “dub” sound of heart?

Answer 22

S2, 2nd sound

indicates end of systole

Question 23

S3 heart sound info

Answer 23

normally not present
Dull low pitched

S3 usually indicates HF in >30 yr

Question 24

S4 heart sound info

Answer 24

normally not present
Dull low pitched
“a stiff wall”

Question 25

Systolic click

Answer 25

high pitched

Signifies doming of stenotic yet flexible valve

Question 26

Diastolic Snap

Answer 26

high pitched

signifies doming of stenotic yet flexible valve

Question 27

Heart murmur

Answer 27

results from turbulent blood flow within heart chambers or across valves

Question 28

Factors for Heart Murmur

Answer 28

high flow rate through normal valve

forward flow through constricted or irregular valve

Backward flow through incompetent valve

Decreased viscosity

Question 29

Heart murmur classification

Answer 29

timing and duration during cycle
location on chest wall
intensity (1-6)
pitch
radiation

Question 30

Cause of Systolic Murmur

Answer 30

failure of aortic and pulmonary valves to open or leakage of the mitral and tricuspid valves

Question 31

Cause of Diastolic Murmur

Answer 31

stenosis of mitral or tricuspid valve and aortic & pulmonary valve regurgitation

Question 32

When should pharmacologic intervention be initiated with HTN?

Answer 32

ASCVD risk >10%, 130/80

or

ASCVD risk <10%, 140/90